Gait Training

Question 1

Components of Gait Training

Answer 1

• PRE-GAIT INITIATION
• AMBULATION OVER LEVEL SURFACES
• AMBULATION ON UNEVEN SURFACES
• CORNER NEGOTIATION
• CURB/STAIR NEGOTIATION
• RAMPS/HILLS
• FLOOR TRANSFERS

Question 2

Level ambulation progression

Answer 2

• parallel bars
• walker/bilateral crutches
• unilateral device
• no device

Question 3

What should you promote during level ambulation

Answer 3

• normal gait mechanics
• heel to toe pattern
• equal step length and stance times
• pelvic and trunk rotation (gotta get normal pelvic rotation back to decrease risk of lumbar/back pain)

Question 4

Energy expenditure with prosthetic gait

Answer 4

• energy expenditure leg amputees use more energy to walk the same distance that non-amputees do
• amputees have higher levels of oxygen consumption
  *** they may need more breaks

Question 5

Why are crutches better than walker?

Answer 5

can take normal step length

Question 6

which direction does TTA patient typically fall

Answer 6

posterior and to amputation side

Question 7

which direction do patients with mechanical knee typically fall?

Answer 7

likely will buckle and fall forward
- you should stand on side of prothesis and anterior

Question 8

3 things you need for successful gait

Answer 8

• pelvic rotation
• heel to toe gait
• full weight shift

Question 9

Breaking gait into sequences

Answer 9

• staggered stance with weight shifting
• step onto prosthetic limb with sound limb swing
• step onto sound limb with prosthetic limb swing
• transverse pelvic rotation

Question 10

Transfemoral Pre-Gait Training

Answer 10

• LEARN HOW TO CONTROL KNEE
  (LOCKING/UNLOCKING)
• SWING – UNLOCK KNEE BY ENGAGING HIP FLEXORS
  AND PUTTING WEIGHT ON PROSTHETIC TOE
• STANCE - LOCK KNEE BY ENGAGING HIP EXTENSORS
  WITH WEIGHT ON HEEL
• DON’T NEED TO DO WITH MICROPROCESSOR KNEES

Question 11

corner negotiation

Answer 11

• take bigger step with outside foot and pivot on inside foot
• outside foot can be either prosthetic or sound
• initially more pts prefer to pivot on sound limb
• use wide turns to avoid loss of balance and knee strain on pivoting foot
• practice both directions

Question 12

General progression for stairs

Answer 12

• bilateral railings
• one railing and device
• one railing
• device only
• no rails

Question 13

Ascending stairs

Answer 13

lead with sound side

Question 14

descending stairs

Answer 14

lead with prosthetic side

Question 15

TFA stairs prognosis

Answer 15

• probs gonna have a step to gait for ascending, can possibly do reciprocal going down
• microprocessor knee can eventually do reciprocal

Question 16

Stair negotiation - TTA

Answer 16

able to ascend and descend reciprocally due to intact knee joint

Question 17

stair decent with hydraulic knee

Answer 17

• have sufficient friction at ranges greater than 20 deg knee flex to facilitate reciprocal pattern
• descend by placing prosthetic foot halfway off step

Question 18

non hydraulic knee stair negotiation

Answer 18

• no friction at greater than 20 deg knee flex - controlled fall
• requires significant amount of balance and motor control as well as confidence
• can use step ups with prosthesis to promote WB and hip ext strength

Question 19

why are ramps/slopes challenging for prothetic users

Answer 19

• stiffness of ankle: less adaptable to incline/decline
• TF: lack of knee and eccentric quads control

Question 20

two strategies to navigate ramps/curbs

Answer 20

1. shorten step length of involved limb (step to pattern)
2. turn partially sideways and use a side stepping pattern or zig-zag pattern

Question 21

floor transfer

Answer 21

• perform early on in treatment
• perform with and without prosthesis
• push up on furniture
• push up on assistive device

Question 22

how to do floor transfer

Answer 22

1. pivot on sound limb
2. get in quadruped
3. sound limp propped up
4. push through sound limb and find something to pull yourself up

Question 23

special considerations - microprocessor knees

Answer 23

• 70% of body weight indicates stance phase resulting in increased friction
• Need to WB 70% BW on forefoot for 0.1 sec to unlock knee
• can facilitate knee flex up to 20 deg at initial contact

Question 24

to change from stance phase to swing phase with microprocessor knee:

Answer 24

• must weight shift onto prosthesis for stance and off for swing

Question 25

Special Considerations - Stubbies

Answer 25

• used for initial training with Bilateral TFA
• shorter pylons
• lowers center of gravity
• makes initial balance and use easier
• some patients like to use in home

Question 26

Special Considerations - running with a prosthesis

Answer 26

• intact leg acts like a spring to absorb impact forces, store energy, and return at push-off for propulsion
• elasticity of achilles tendon reduces workload of gastroc/soleus complex
• impact forces can be as high as 2x body weight depending on running pattern

Question 27

what do TTA runners rely on?

Answer 27

hip/ knee extensors

Question 28

more considerations for TTA runners

Answer 28

• shorter swing time = shorter step length = lower GRF
• stiffness on prosthetic components does not change in step frequency
• have to adapt running pattern to inherent stiffness of running prothesis

Question 29

more considerations for TFA runners

Answer 29

• delay in prosthetic swing resulting in hop-skip method
• reduce hip flex at end-swing in preparation fro stable heel strike –> shorter step length
• greater loading impact force translated to residual limb
• energy-storing foot reproduces 0.97 GRF absorbed
• pattern will be dictated by prosthetic knee component